The purpose of this cross-sectional study was to examine the association between mammogram adherence in Filipino American women` and 3 factors: need, enabling and predisposing. These factors were represented by 10 predictor variables: breast cancer literacy, number of mammogram referrals by a healthcare provider, health insurance, sociocultural deterrents, fatalism, symptomatic deterrents, catastrophic disease expectations, negative health beliefs about healthcare professionals, nativity and years of residence in the United States. The factors and variables corresponded with the need, enabling and predisposing factors in Andersen’s Behavioral Model for the Utilization of Health Services which served as the conceptual framework of this study. The expanded version of Andersen’s model, which contained need, enabling and predisposing factors unique to vulnerable population groups, was used.
The convenience sample consisted of 157 Filipino American women, who were at least 40 years old, living in the United States and had never been diagnosed with breast cancer or breast disease. The sample was highly educated with 33.8% having postgraduate credits or a post-graduate degree, 59.9% had a college degree and only 4 women (2.5%) had less than a college degree. Not surprisingly, all but 3 women had health insurance. Many of these Filipino American women lived in a household where there were at least two incomes (N = 117, 74.5%), a few (N = 28, 17.8%) lived in one-income households and only 6 (3.8%) lived in a household where there was no income-earner declared. Five Filipino American women were born in the United States, the rest of the women (N = 148, 94.3%) were born in the Philippines. The average time of residence in the United States was 25.09 (±11.18) years.
Logistic regression models were analyzed to determine the association between study variables and mammogram adherence. Model 1 pertained to the need factor in Andersen’s Behavioral Health Model. The need factor consisted of 2 variables: breast cancer literacy and mammogram referral by a healthcare provider. Model 2 pertained to the enabling factor in Andersen’s Behavioral Health Model. The enabling factor consisted of 2 variables: health insurance and sociocultural deterrents. Model 3 corresponded to the predisposing factor in Andersen’s Behavioral Health Model. The predisposing factor consisted of 5 variables: fatalism, symptomatic deterrents, catastrophic disease expectations, negative health beliefs about healthcare professionals, nativity and years of residence in the United States. Two of these variables–nativity and health insurance–were deleted because these violated the assumption of cell frequency.
Of the variables in the logistic regression models, only 1 was statistically significant–the number of mammogram referrals by a healthcare provider. In Model 4, the odds of a Filipino American woman being mammogram adherent vs. non-adherent were 213% higher (AOR = 2.133; 95% CI, 1.094, 4.160; p-value = .026) for each additional mammogram referral from a healthcare provider, controlling for other variables in the model.
Breast cancer is one of the most commonly diagnosed cancers among Filipino American women. Breast cancer disparities in Filipino American women exist in terms of mortality, age at diagnosis, tumor characteristics, diagnostic follow-up and treatment modalities. Mammography is a proven technology to detect breast cancer early when it is most treatable and helps alleviate some of these disparities. However, Filipino American women have had historically low mammogram adherence rates. What this study contributed is that a referral from a healthcare professional is most determinative of mammogram adherence. This study provides a basis that policy be directed towards encouraging, monitoring and incentivizing healthcare professions to promote cancer screening.
|Commitee:||Wallace, Debra, Morrison, Sharon, McCoy, Thomas|
|School:||The University of North Carolina at Greensboro|
|Department:||School of Nursing|
|School Location:||United States -- North Carolina|
|Source:||DAI-A 81/1(E), Dissertation Abstracts International|
|Subjects:||Public Health Education, Oncology, Asian American Studies|
|Keywords:||Breast cancer, Culture, Filipino, Healthcare provider, Health literacy, Mammogram adherence|
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